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January 12, 2016

An Expert in Your Field – So act like it.

By | Nursing | 15 Comments

This morning I was a skilled and confident nurse in a cardiology procedural setting.  I comforted my patient, who was about to have what is arguably the most dangerous procedure we do in my specialty.  We laughed, I teased him, and made jokes about drawing a mustache on him while he was sleeping. He had a great time with it, relaxed and became comfortable with my care. He asked questions about the procedure, had his fears acknowledged and the particulars explained. He was smiling when we brought him into the procedure room, and was anesthetized while holding my hand. I was the last person he saw before he slept, and I knew I made a difference.

And this afternoon I unsuccessfully attempted to comfort my 12-year-old, terrified of having his braces put on. The Orthodontist’s office staff had him calmed down in five minutes. Because they knew what to say.  Because my son acknowledged them as experts in their field.  He did not have the same confidence in me. I was also truly uncomfortable in that setting.  I am sure he knew it.

We have so many different kinds of nurses in Show Me Your Stethoscope.  No two of us are exactly the same, and that is part of the magic.  We have literally tens of thousands of experts in nursing specialties far and wide.  I wouldn’t even try to name the represented fields here.  You know who you are and what you do.

Nurses are terribly hard on each other.  Many of us are shocked when another nurse doesn’t know a fact we consider elementary.

So, I need you to find a HIS on this electrogram.asirvatham8



Right. Because only a few thousand of you had even seen one of these before.  Interpreting it would be impossible.  If you worked in this setting, you may have only sedated the patient or recorded.  Many nurses do not choose to become skilled at this even when they work in this specialty.  It’s hard, and I am learning something new several times every single case.

Now ask me to handle a TOCO.  No idea.  I had a patient with a TOCO in the ICU years ago. She had a head bleed.  Whenever the TOCO started spewing out paper and alarming, I quietly flipped out.  A skilled specialist from Labor and Delivery would arrive a few moments later, usually to adjust the elastic belts over my patient’s gravid abdomen.  No doubt I disturbed them when I turned her.

I didn’t even know enough about it to fix it. They never complained. toco

I know that my specialty is not common knowledge.  Do you? Are you patient and calm when you transfer patients between facilities and specialties? Are you willing to make these transfers a learning experience, instead of a stressful time for both nurses involved?

Let’s start with a few rules of the road.  I think we can all benefit from this.

  • Assume the person you are talking to is an expert in their field as well.  Just because you would expect certain information to be offered in report, don’t assume the person knows you want it.  Expectations are Premeditated Resentments.  For example, when receiving report from an ER Nurse, do not expect them to know when the patient’s last BM was unless they are here for a GI complaint.  The focused assessment is key in the ER. When receiving report from a LTC Nurse, they are going to give you a LOT of valuable information because they know the patient very well. Do not dismiss their information as useless just because there is a lot of it.  It is usually spot on and pertinent. You have 5 minutes, I promise.
  • Take 30 seconds to write down the extremely important things before you call report. I have found that this makes me less annoyed when I get interrupted in the middle of report and lose my train of thought.
  • Do not use specialty-specific jargon when giving report.  I could tell you all about our patient’s AVNRT, and slow pathway.  However, that wouldn’t be helpful at all.  Be Helpful. So….I am just going to say that Mr. Smith has a successful SVT ablation, and is now in Sinus Rhythm at 68. Jargon makes people tune out.
  •  Answer any questions the person receiving report wants answered. Your time is not more valuable than anyone else’s.  Do not allow an annoyed tone to creep into your voice because you are busy;we are all busy.  Transferring a patient is a routine thing for everyone except the patient.  Let’s make the transition go as easily as we can.
  • Attempt to get to know the people you give report to frequently.  You know it is easier to deal with people who like and respect you.  Give respect so you receive it.  Be friendly, helpful, and do what is right for your patient.  

I think that is enough for today.  But I have two requests for you:Maya

  1. Give us a piece of your specialty-specific jargon and tell us what it means!
  2. Start over tomorrow with a new attitude if you need to do so.  It is NEVER too late to be kind.





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